2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

On the Shoulders of Giants: The Path to Building Supportive Housing

It was the summer of 1979, July 5th to be exact, the first day of my internship at Community Access. My job was to help run a pair of tenement buildings with 44 apartments that provided cheap homes to poor families and single men and women who had been recently discharged from state psychiatric facilities. The buildings had seen better days, but looking at Jacob Riis’ photographs of the squalid, cramped conditions almost 100 years earlier, it was difficult to pinpoint precisely when these particular apartments had ever been “nice.”

Nevertheless, I was 27 and delighted to be right where I was. I had promised the Board of Directors at Community Access that I would do whatever I could to improve the lot of the tenants and the rundown buildings that they called home. In two months, I would start my second year of graduate school, so I knew I had to work fast, not knowing I would have another three decades at my disposal.

I would also discover, years later, that what I had stumbled upon was a “model program” that would eventually be called supportive housing. I would also learn that there’s a long history of visionary efforts to provide humane services and homes for people diagnosed with mental illness. I had no clue I was standing on the shoulders of giants!

One early form of community integration for people with emotional problems appeared in Geel, Belgium. Drawn by the story of St. Dymphna, the patron saint of the mentally ill, thousands of people have made a pilgrimage over the centuries seeking relief from their symptoms. The flow of people seeking a cure became overwhelming and many were eventually taken in by local residents, a tradition that has continued for hundreds of years.

In pre-industrial societies, care for people with mental illness fell to the families and the close-knit communities where they lived—as still happens in many non-Western countries today. There was always a task and a role for someone, no matter what their particular limitations might be. Unfortunately, there were also many misconceptions about the nature of mental illness, which led to bizarre and horrific forms of “treatment” that would be characterized as torture today. Reformers in the late 18th century began advocating for a completely different approach, called “moral treatment” that emphasized compassionate care in asylums, which were widely adopted in the United States through the effective advocacy of Dorothea Dix.

In the 19th century, care by families and the community changed dramatically with the advent of the industrial age and the division of labor. People in the community who needed extra support or attention were suddenly a burden to the family. Asylums, originally envisioned as havens for humane care, became large institutional settings for anyone who was disabled, diseased, or otherwise socially unfit.

In the late 19th century, New York State, in an extraordinary burst of social and political action unimaginable now, undertook to reform the discredited asylum approach by constructing a system of hospitals, mostly in rural communities, that were dubbed “farm colonies” because of their live-and-work treatment programs and emphasis on agriculture.” Many featured golf courses and spacious private homes for the senior directors. And much like prisons today, the institutions were a source of stable employment for generations of New Yorkers, whose elected representatives protected their survival for decades. By 1910 over 31,000 patients were in these facilities, the largest institutionalized population in the country. By 1955, at the peak of the institutional system, there were over 93,000 patients living in 33 overcrowded facilities in which treatment often included physical restraints, seclusion rooms, and frontal lobotomies.

The enormous cost of maintaining this system, combined with another wave of social reform and the widespread adoption of psychotropic medication, led to the creation of community-based clinics and outpatient services, but little housing, for thousands of discharged patients. In New York City, as in many other communities, former patients crowded into single room occupancy (SRO) hotels and rooming houses. And, with the creation of the Supplemental Security Income (SSI) program in 1972, many people with disabilities were able to manage a semi-independent life.

This fragile arrangement didn’t last long, however. Using a law (J-51) created in 1955 to encourage owners to install hot water plumbing, SRO owners were rewarded generous property tax abatements (“…just a lovely gift from the city…”) to convert their low rent SROs into market-rate apartments. An estimated 150,000 SRO units disappeared between 1970 and 1990, leading to a surge in homelessness for the thousands of poor and disabled people who relied on this housing resource.

My path to Community Access started in 1978 as a project for the Mayor’s Office of SRO Housing. This unit was created in 1973 to develop policies and monitor conditions in the SROs. As part of this mandate, our team of students at the New School was asked to evaluate the various approaches being attempted to either replace the lost SRO units or preserve them and improve the care of the tenants. We were fortunate to meet not only the founders of Community Access, but many of the pioneers of today’s supportive housing movement.

However, there were a lot of things I didn’t know in the summer of 1979: A young corporate lawyer, about my age, Bob Hayes, was preparing a lawsuit that would radically change public policy and its response to homelessness by establishing a right to shelter. Two researchers, Kim Hopper and Ellen Baxter, were also conducting field work that would lead to their seminal study, “Private Lives/Public Spaces,” which documented the prevalence of mental illness among the street homeless. Ellen went on to form the Committee for The Heights Inwood Homeless (now Broadway Housing Communities) and renovated an apartment building on West 178th Street into 55 units of supportive housing for the homeless. Bob, Kim, and Ellen also formed the Coalition for the Homeless in 1981.

Also in the works during the summer of 1979 was the development of the first St. Francis Residence, a 97-unit building developed by two Franciscan Friars, John Felice and John McVean, which opened in 1980. This model retained the basic features of an old SRO and brought services to the residents on an as-needed basis. They developed two more sites, over 300 units, and then stopped, based on the principle that this was as many people as they could know personally at one time.

During the 1980s, many other groups began to reclaim the threatened SROs, perceiving them to be a valuable housing resource in their community. Primarily on Manhattan’s Upper West Side, many of these buildings remain in operation today. The early leaders in this group include Goddard-Riverside, Broadway Housing Community, CUCS, Jericho Project, Project FIND, West End Intergenerational Residence, West Side Federation of Senior and Supportive Housing, and Urban Pathways. These groups helped form the SRO Providers Group in 1988, which was renamed the Supportive Housing Network in 1992.

In August 1990, then-Governor Mario Cuomo held a press conference on the sidewalk in front of St. Francis Residence III to announce a new initiative called the New York/New York Agreement to House Homeless Mentally Ill Individuals. This landmark, 6-page document resolved years of debate between New York City and the State over who should take responsibility for mentally ill people on the streets and in the city’s shelters.

The NY/NY agreement committed the parties to develop and fund 5,200 units of supportive housing in New York City and was the foundation for two subsequent agreements to add over 10,000 more units. Combined with a new federal affordable housing initiative created in 1986, the Low Income Housing Tax Credit program, there was now a stable source of construction, operating, and support services funding for nonprofit groups to develop new housing. The Corporation for Supportive Housing (CSH) was created in 1991 by Julie Sandorf to help nonprofits package and develop projects using these new sources of funds. CSH now has offices in eleven states and is a leader in financing new housing and disseminating information on innovative practices.

Today there are over 43,000 units of supportive housing across New York State, developed and operated by almost 200 nonprofit organizations. In addition, many nonprofits are now collaborating with for-profit developers as supportive housing has evolved into a mainstream option for any affordable housing development. As an example, Community Access recently helped 47 formerly homeless people sign leases in a 225-unit affordable housing project sponsored by a private developer, Kiumarz Giula.

My experience managing the two tenement buildings between 1979 and 1981 (when they were eventually razed for an urban renewal project) led to future Community Access initiatives, including the development of 17 housing programs—several of which integrate low income families and formerly homeless adults with mental illness—and the active inclusion of program participants and peers in our planning and program operations.

So what began in 1979 as a summer internship, has turned into a career that has allowed me to be a part of a revolution in the way New York, and now many other communities throughout the U.S. and abroad, approach the housing needs, and human rights, of people who in past generations would have lived out their days in institutions or desolate squalor.

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